Healthcare Provider Details

I. General information

NPI: 1700858206
Provider Name (Legal Business Name): VICTORIA A HILL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VICTORIA A SPAIN PA

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N WICKHAM RD STE 202
MELBOURNE FL
32935-8660
US

IV. Provider business mailing address

240 N WICKHAM RD STE 202
MELBOURNE FL
32935-8660
US

V. Phone/Fax

Practice location:
  • Phone: 321-541-1746
  • Fax: 321-676-2613
Mailing address:
  • Phone: 321-541-1746
  • Fax: 321-676-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0001-03562
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: